{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert Elliott","gend":0,"currentgend":"","add":"375 NORTHEAST MAIN ST","city":"DOUGLAS","state":"MA","zip":"01516","dob":"1966-02-16","age":"","mstatus":"","insh":"C0027261000","cliId":"","pno":"7742722999","cno":"","email":"","ename":"","eno":"","pphy":"Krzysztof  Kacprzak","ppno":"5084610011","pcpadd":"72 Cudworth Rd","pcpcity":"Webster","pcpstate":"MA","pcpzip":"01570","pcpcounty":"","pcpid":"","pcpname":"Inter Med Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"3","add3":"","madd1":"375 NORTHEAST MAIN ST","madd2":"3","madd3":"","mcity":"DOUGLAS","mstate":"MA","mzip":"01516","pcpfaxno":"","pcpnpi":"1952364523","currentgendcomment":"","pphycomment":"","uniqueid":"132147950","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","I4891","I10","E7800","Z87891","Z79899","Z79891","Z886","G479","Z1331","E6609","Z6833","Z0000","I2510","R002","R079","I4819","R000","Z139","Z6830","M25532","M25561","E662","E663","M79642","M19032","M1812","M79646","M7541","M25342","Z0389","J3489","Z6832","L723","Z4802","L720","M795"],"date":["2026-04-21","2026-04-23","2026-03-15","2026-04-23","2026-03-15","2026-03-15","2026-03-15","2026-03-15","2026-04-20","2026-04-20","2026-04-20","2025-10-20","2026-04-20","2026-03-14","2026-03-15","2026-03-15","2026-03-15","2026-03-15","2026-04-20","2026-04-20","2026-04-20","2026-04-23","2026-04-23","2026-04-23","2024-08-12","2024-07-25","2024-08-26","2024-08-26","2024-07-16","2024-07-25","2024-09-16","2024-09-16","2025-04-17","2024-12-27","2025-01-30","2025-01-24","2025-05-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}